Dr. Kovarik – Teledermatology (Podcast #2)

– Ryan O’Keefe, MS1 –

I had the privilege of sitting down with Dr. Kovarik to discuss her career, and how she became a leader in the field of teledermatology. Dr. Kovarik grew up in Texas and studied electrical engineering at Texas A+M. Having worked for a number of years at AT+T before moving on to medicine, she was uniquely positioned to apply her understanding of the communications world to medicine. Dr. Kovarik was drawn to pathology and dermatology because they were visual-focused fields. She has been in medicine for 11 years now, and has used her wide-ranging skills to apply telecommunications technology to underserved populations, most notably those in Africa.

Some of the major takeaways from our discussion:

1.) You can leverage your outside interests and knowledge into the medical field

It’s not always easy, but if you can define what you most want out of medicine, you can find a way to make it happen. Dr. Kovarik knew she wanted to leverage telecommunications technology to benefit underserved global populations, and that she preferred working in a field that would be visual. Taken together, teledermatology was the perfect fit, and at the time it was only just beginning. It may seem obvious at face value, but deeply knowing what you want is crucial for making it happen.

 

2.) Teledermatology is not Skype, and is way different than just outsourcing diagnoses

Before doing research for our discussion, I had assumed that anything with a “tele” at the start meant you’d be Skype-chatting with a doctor. However, telemedicine is not the same thing as teledermatology, though they share some similarities. At the present, teledermatology centers around storing and transferring images to dermatologists who can make diagnoses and provide instructions for treatment from afar. The key thing is that with teledermatology, physicians are both diagnosing AND giving treatment instructions. Thus, it is critical that the dermatologist understands the community where the patient lives, the culture, and the treatments and medications available to them. When outsourcing radiology work, the output is usually just an impression. There is less liability, because no treatment plan is laid out, and the work must be double-checked. Thus, there are a unique set of problems that those in teledermatology must address in the coming years before it can grow.

3.) The barriers to the growth of teledermatology are not insurmountable, but will require policy changes and activism

Currently, the obstacles facing teledermatology include liability, reimbursement, and scaling. While some programs, like the Botswana UPenn-Partnership, negotiate directly with foreign governments to lay the ground rules for the relationship, it can be tricky. In the coming years, policy changes will be necessary, and passionate physicians will need to lead the charge, demonstrate the value of teledermatology, and justify reimbursement by showing the hard work they must put in to make it successful.

 

Check out this article for more info on Dr. Kovarik and her efforts to improve and spread teledermatology services across the U.S and the rest of the globe.

 

– Ryan is a first year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’keefe@uphs.upenn.edu –

Dr. David Fajgenbaum: Lessons and Takeaways (Podcast #1)

Ryan O’Keefe, MS1

Penn Health-X had the pleasure of welcoming Dr. David Fajgenbaum MD, MBA, MSc to be our first seminar series speaker this semester. Dr. Fajgenbaum shared the story of his struggle with Castleman Disease, and establishing the Castleman Disease Collaborative Network (CDCN). He also shared some advice on becoming a physician leader. After his talk, we were lucky enough to interview him for the very first Penn Health-X Podcast, in which we delved into more detail. You can find the podcast here.

Check out the article recently published in the New York Times on Dr. Fajgenbaum and his work with the CDCN. On the podcast, we filled in some of the blanks in the narrative presented by the Times.

Also check out an article published on UPenn’s website about Dr. Fajgenbaum.

There were a few major takeaways we’d like to share here.

1. Having previous success running an organization certainly helps, but at the end of the day starting something great begins with an email

Dr. Fajgenbaum started National Students of AMF when he was still an undergraduate student at Georgetown. Dr. Fajgenbaum’s mother was found to have a brain tumor, and she sadly passed away shortly thereafter. In her memory, Dr. Fajgenbaum knew he wanted to start something using her initials – A.M.F – but didn’t yet know what that would be. He ultimately realized that there was a huge need for grief support for college students, and so he began the National Students of AMF, and watched as chapters opened up on campuses across the U.S. AMF, now an acronym for “Always Moving Forward”, is meant to help students through the process of grieving, and is still active and helping thousands.

Dr. Fajgenbaum agreed that having the experience of starting and growing a national organization later gave him the confidence to start the CDCN when he recognized there was a need in the research community. He mentioned that it definitely helps to have a series of small wins in your pocket to build up your confidence. But at the end of the day, starting the CDCN began with an email. And then another email. And then thousands more. Great organizations and accomplishments seem so stable, and we assume that only natural leaders who have innate knowledge of what they need to do can start them. We forget that most actually begin with just an idea, and a humble email.

2. Find your mentors, and then stand on their shoulders

Though Dr. Fajgenbaum was driven, intelligent, and desperate for solutions, guidance from mentors, and using some of their clout, was a necessity in establishing the CDCN. Dr. Fajgenbaum pointed to Dr. Arthur Rubenstein , and Dr. Fritz van Rhee  as two of his earliest mentors. When sending out the very first emails to physicians to invite them to be a part of the CDCN, he included both of their names. It was essentially the subtle email version of name-dropping. Even with the support and involvement of two prominent names in orphan disease research, he didn’t hear back from most of the people he reached out to. Imagine the response rate if he tried to do it all on his own. When it comes down to making your passion projects a reality, there’s no shame in flexing your network muscles and enlisting the help of those with prominence. In fact, doing so is what gives you the greatest chance of success.

3. Not everyone has access to a business education, but everyone has access to the internet and to books

If you want to be a physician leader in the H-MET space, or in any area of healthcare, you will need to learn some basic business skills. While Dr. Fajgenbaum opted to complete an MBA degree at Wharton, where he picked up some of these skills and was able to grow his network, not everyone has the opportunity to get an MBA, let alone at one of the best schools in the country. Yet, Dr. Fajgenbaum was adamant that if you identify the skills you need to practice, and have the drive, books may be all you need. Two skills that Dr. Fajgenbaum believe were critical to the success of the CDCN include knowing how to properly correspond with others (especially via email), and knowing how to negotiate.

Dr. Fajgenbaum mentioned the book Getting More: How You Can Negotiate to Succeed in Work and Life by Wharton professor Stuart Diamond, as one of his favorites. Those in medical school or interested in the sciences may believe that research and medicine are apolitical, and that everyone works together for a common good. I remember having those thoughts when I was in high school. I distinctly remember saying to myself “I want to go into a field that isn’t political – medicine.” That’s laughable and naive these days, but many laypeople and those early in their education – the bright-eyed and bushy tailed among us – still believe that this is how the research world works. Dr. Fajgnebaum mentioned that dealing with egos, differing interests, and money was something he was not nearly prepared to do. Understanding how to negotiate is critical. This includes creating win-win scenarios, and learning how to frame proposals in another person’s interest. If you haven’t yet read the classics, such as Dale Carnegie’s How to Win Friends and Influence People, or Robert Cialdini’s Influence: The Psychology of Persuasion  – why? There’s a reason they are timeless.

Beyond negotiations, when reaching out to physicians, Dr. Fajgenbaum always personalized the messages. Though this can be time consuming, especially when hundreds of emails need to go out, you improve the chances that someone will respond, no matter how busy they are. He mentioned that he would include references to their past research. It’s no surprise that people love discussing themselves and their accomplishments. Learning to stroke someone’s ego is not simply flattery, it’s a way to get someone to listen to you. You can have the best, most important idea out there, but if no one is listening, or replying to your emails, what good is it? You may think it boils down to “be a nice person”, but that’s the bare minimum!

Here are some great sources on how to get a reply from someone you’d like to speak with. It only took a few googles to find what I was looking for. That’s powerful.

https://www.themuse.com/advice/introducing-the-email-template-thatll-get-you-a-meeting-with-anyone-you-ask

https://www.themuse.com/advice/how-to-ask-for-an-informational-interview-and-get-a-yes

http://academy.justjobs.com/informational-interview-e-mail-templates/

Final Thoughts

You may be concerned that there isn’t enough time to read a few business books, or find the perfect mentors, or send the 300 emails to get your project off the ground. After all, they don’t test negotiations on STEP 1, and the coagulation cascade isn’t going to learn itself. Speaking with Dr. Fajgenbaum made one thing clear – you need to dig your well before you are thirsty. These skills may not seem entirely relevant, but when you have that great idea, or see an opportunity emerge, you want to make sure you have the resources and skills to go after what you want. Undoubtedly, starting anything is trial and error. But the more prepared you are, the less error.

 

– Ryan is a first year medical student at the Perelman School of Medicine. He is the co-VP of curriculum for Penn Health-X, the co-host of the Penn Health-X podcast, and founder/editor-in-chief of the Penn Health-X blog. You can contact him at ryan.o’keefe@uphs.upenn.edu –